Provider Demographics
NPI:1306446687
Name:SCOTT, LISA JODALE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JODALE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 TUG FORK DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:BELFRY
Mailing Address - State:KY
Mailing Address - Zip Code:41514-9170
Mailing Address - Country:US
Mailing Address - Phone:606-237-9730
Mailing Address - Fax:
Practice Address - Street 1:38 TUG FORK DR APT 3A
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-9170
Practice Address - Country:US
Practice Address - Phone:606-237-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant